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Wednesday, July 29, 2009

Beware the Spinal Trap

On 29th July a number of magazines and websites are going to be publishing Simon Singh’s Guardian article on chiropractic from April 2008, with the part the BCA sued him for removed.

They are reprinting it, following the lead of Wilson da Silva at COSMOS magazine, because they think the public should have access to the evidence and the arguments in it that were lost when the Guardian withdrew the article after the British Chiropractic Association sued for libel.

We want as many people as possible around the world to print it or put it live on the internet at the same time to make an interesting story and prove that threatening libel or bringing a libel case against a science writer won’t necessarily shut down the debate.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Boggles the mind... but I suppose I shouldn't be surprised anymore about findings such as these (reproducing a press release from York University, Toronto, Canada):

Nurses stung by racism on the job, York U research finds

Nurses in Ontario experience racism on the job from patients, doctors, nurse managers, and most often from other nurses, research by a York University professor has found.

“I would call it a new racism, a subtle but systemic form,” says professor Tania Das Gupta, Chair of the Department of Equity Studies in York’s Faculty of Liberal Arts and Professional Studies. “It doesn’t use the language of racism, but it ranges from comments about accents and physical attributes, to a failure to recognize the nurse’s skills and knowledge.”

In the survey, 41 per cent responded that they had been made to feel uncomfortable because of their race, colour or ethnicity. Most Black/African Canadian nurses (82 per cent) and Asian Canadian nurses (80 per cent) said they had experienced this, as well as 50 per cent of South Asian Canadian nurses and 57 per cent of Central/South American Canadian nurses. Even 25 per cent of the white/European Canadian nurses said they had been made to feel uncomfortablebecause of their ethnicity or religion, said Das Gupta.

The results of the survey, which was conducted a few years ago, are analyzed in Das Gupta’s recent book, Real Nurses & Others: Racism in Nursing (Fernwood, 2009). The title for the book came from the experience of one black nurse who was asked often if she was a “real” nurse.

Das Gupta decided to study racism in nursing closely because she had often been called as an expert witness in racial discrimination cases involving nurses. She expected that most of the racism toward nurses would come from their patients or managers, but the greatest proportion – 27.3 per cent – was from co-workers. Patients were the next most likely group to express racism (23.8 per cent), followed by doctors (14.3 per cent) and nursing managers (12.8 per cent).

Systemic racism in institutions arises from conscious or unconscious policies, procedures and practices that adversely affect people of colour, including their exclusion, marginalization and infantilization, says Das Gupta. Her research examines how fear, lack of support, management collaboration, co-worker harassment and ineffective institutional responses make it difficult for victims of racism to fight back.

Surprisingly, most nurses who experience racism don’t take the issue to their union, but try to handle it on their own, says Das Gupta. This is significant because 58.1 per cent of black/African nurses and 48.3 per cent of Asian nurses perceived that their race, ethnicity or colour affected their relationship with their colleagues, while 54.8 per cent of black/African nurses, 46.7 per cent of Asian and 44.4 per cent of South Asian nurses said it affected their relationship with their manager.

“Both those relationships can affect job promotion and there’s a pattern of differential treatment,” said Das Gupta. ”I think there’s a role for government to play to address this kind of systemic racism, as well as unions, employers, educators and even community groups.”

Not that I like BMW (the brand and most of its cars), but I am delighted about the company's decision to withdraw its Formula 1 sponsorship (and team, I hope). Seriously, in an age where everyone's going on about reducing energy wastage, we got guys driving around in circles in overpowered racing cars. I wonder how many people watch this stuff hoping to see the next big accident. Anyhow, another major team down... few to go :0).

Thursday, July 23, 2009

Read from top :-). enjoy the excellent command of the English language. Note that it's all blessed by God (end of blurb), too, so there's no need to worry that this just might be another scam :). Uneducated as these folks are, they don't even seem to know that prime in most places these days is below 3%, so their supposed offer wouldn't even be competitive if it was serious :0). Oh well...

I got your mail and i want you to know that this very company is known for good things and excellent works,I want you to be rest assure that your loaning here will never be in vain. For further procedure of your loan transfer,Please you are advised to fill the information needed bellow in order for we to be able to start the processing papers of your loan. And i want you to know that i can help you with any type of loan at 3% interest rate.

The Montreal Gazette points out that the Quebecoise electorate has been more progressive than voters in other Canadian provinces, with about 80% favouring the legalisation of voluntary euthanasia. Conservative religious people are naturally not bemused, and their lobbyists dragged out flawed stuff like the doctrine of the double-effect and the intention-foresight distinction.

Simply put: these people believe that if someone dies as a foreseeable side-effect of having received large quantities of pain killers that is not euthanasia provided the doctor's decision was to relief pain and not to kill the patient. Of course, the effect is the same: the patient dies as a foreseeable consequence of her doctor's intervention. To say that I don't mean to do X when I know that X is the inevitable result of my actions is probably intelligible (after all, I might accept X as an unwanted but inevitable thing, in order to achieve something else, say the alleviation of pain). And yet, it seems deeply dishonest to go on about this distinction when it is clear that I will kill a given patient if I intervene in a particular way (even if my intention is otherwise). Seems like camomile for the tortured guilty conscience. Perhaps it is time to consider whether it would be better to permit people legal access to this option to avoid endless probes into doctors' intentions. It would appear to be more sensible to focus on the outcomes of actions and decide whether or not they are desirable. The double-effect doctrine and the intention-foresight distinction are not particularly helpful, when looked at from this perspective.

Canada at this point in time outlaws voluntary euthanasia, as well as physician assisted suicide (in this case the doctor would not administer the drug to terminate your life, she would only make them available to you so that you can commit suicide yourself if you so wish).

Monday, July 13, 2009

You might recall my criticism of more or less unprofessional conduct by the Journal of the American Medical Association's current editors. It's a story that began here, continued here, with the last post being this one. Apparently the WALL STREET JOURNAL's health blog (kindly citing my blog) asked JAMA for a reply to the criticism I raised both on this blog as well as on a mailing list of the World Association of Medical Editors. According to the Wall Street Journal's health writers the JAMA editors refused to comment. This is much in line with what I have experienced with re to my open questions on the World Association of Medical Editors' listserv. There has been deafening silence, too. It seems to be the case that JAMA's editors are not accountable to anyone with regard to their conduct. They even get away with rewriting the publishing history of the journal they edit.

As a by-product of their shenanigans they flagged (again) the serious problems the scientific publishing community faces with the dawn of the age of on-line only 'publishing'. With the push of a button, scientific publications that once were can simply be made to disappear (and probably also be changed retrospectively). Scientists who criticise an original paper (as was the case with the JAMA on-line editorial that disappeared into thin air) will look a tad bit daft because the article they commented on has disappeared (presumably a result of the egg-on-editors'-face syndrome...). None of this would be possible with print copy publications!

Thursday, July 09, 2009

Hey! You should be so lucky. I got this amazing email from Natalia, completely out of the blue, or, more to the point, out of Russia. I have never heard of her before, but look at her gorgeous face... and she wants to meet me next month. Wow. Anyhow, enjoy her letter ... possible replies to her email are entertained in the comment section. I really would have preferred Dimitri to write, but hey, can't have it all... Udo

----------------------------

Hello my dear friend !!!How are you doing?My name is Natalya. I am 28 years old. My birthday is July,25th. I live in Russia.

Really it is very interesting to me to learn you more and to study you.

I as would like to tell to you about that that I really lonely woman and I very much would like to have acquaintance to the man for serious relations. For this purpose I to address in agency of acquaintances and to give them my letter. To me to tell that I can really find the man through their agency and they to allow me a little e-mail. I to choose yours and very pleasant for me if you answer my letter. I hope that we can study more about each other.

I very much want to have acquaintance with good the man. I as to have some questions for you.How there is your life? What city you live? What you to think about our meeting? You wanted that I could arrive to you in next month?I wish you good day and success.I wait for your letter.Your friend Natalya.

Wednesday, July 08, 2009

You might recall that I posted various blogposts (the last one being this) about the ongoing shenanigans between JAMA and Jonathan Leo.

Here's how the story continues. I copy below a message I just posted to fellow medical editors of the World Association of Medical Editors via our listserv. It's pretty self-explanatory. This truly boggles the mind!

I will keep you posted in case I get a reply.

Colleagues,

you will recall probably the ongoing forth and back between the JAMA editors and Jonathan Leo.

The first document is an on-line publication (incl doi number and all) from March by the JAMA editors. It has been very widely criticized in various fora and condemned pretty much uniformly by everyone with some knowledge of publishing ethics, no least bioethics outlets. What is significant is

a) JAMA has excised its first publication from its website as well as biomedical data-bases (I have no idea how the latter feast was achieved). No retraction notice was published, no erratum of any kind. As one of my colleagues pointed out: what does this mean for the substantial commentary (overhelmingly critical in nature) that was published in various fora on this now non-existent article?

b) My own publisher (Wiley-Blackwell) told me that anything published with a doi number online must not be changed in any print version or on-line without proper errata, withdrawal notes etc.; basically an on-line paper with a doi number ought to be treated just like one would treat a print article. So, one question I have is whether this is simply part of the lex JAMA (continuously revised by the paper's current editors, including seemingly the journal's publication history itself), or whether my publisher has given me false information with regard to the status of on-line publication with doi numbers.

Tuesday, July 07, 2009

In June 2009 millions of people came out on to the streets of Iran for freedom and an end to the Islamic regime. Whilst the June 12 election was a pretext for the protests - elections have never been free or fair in Iran – it has opened the space for people to come to the fore with their own slogans.

The world has been encouraged by the protesters’ bravery and humane demands and horrified by the all-out repression they have faced. It has seen a different image of Iran - one of a population that refuses to kneel even after 30 years of living under Islamic rule.

The dawn that this movement heralds for us across the world is a promising one – one that aims to bring Iran into the 21st century and break the back of the political Islamic movement internationally.

This is a movement that must be supported.

Declaration

We, the undersigned, join Iran Solidarity to declare our unequivocal solidarity with the people of Iran. We hear their call for freedom and stand with them in opposition to the Islamic regime of Iran. We demand:

1. The immediate release of all those imprisoned during the recent protests and all political prisoners2. The arrest and public prosecution of those responsible for the current killings and atrocities and for those committed during the last 30 years3. Proper medical attention to those wounded during the protests and ill-treated and tortured in prison. Information on the status of the dead, wounded and arrested to their families. The wounded and arrested must have access to their family members. Family members must be allowed to bury their loved ones where they choose.4. A ban on torture5. The abolition of the death penalty and stoning6. Unconditional freedom of expression, thought, organisation, demonstration, and strike7. Unconditional freedom of the press and media and an end to restrictions on communications, including the internet, telephone, mobiles and satellite television programmes8. An end to compulsory veiling and gender apartheid9. The abolition of discriminatory laws against women and the establishment of complete equality between men and women10. The complete separation of religion from the state, judiciary, education and religious freedom and atheism as a private matter.

Moreover, we call on all governments and international institutions to isolate the Islamic Republic of Iran and break all diplomatic ties with it. We are opposed to military intervention and economic sanctions because of their adverse affects on people’s lives.

Friday, July 03, 2009

This thing about 'unnatural' sex has been bugging me for a long time. For those of us who are trained to think about what we mean when we say certain things the term 'unnatural' carries no normative weight. For those who think less (either because they quite naturally or culturally cannot think a great deal due to a lack of gray brain matter or lack of education) about what they mean when they say that something is 'unnatural', the 'unnatural' charge routinely leads to demands that certain behaviours or products be outlawed.

Let me look at two examples just from this week, one from Uganda, the other from Jamaica, quite naturally both examples involve Christians on a crusade against gay sex. So, here we go:

Dr. James Nsaba Buturo is the Ugandan Minister of State for Ethics and Integrity. He announced this week that any attempt by donor agencies to have the country legalise 'unnatural' sex (and homosexual sex in particular) will fail. He went on to say that the government is prepared to fortfeit any [sic!] amount of donor money if that meant accepting homosexuality. I'm a consequentialist, so when someone says something like 'no matter what', which is what Dr Buturo's 'any' implies, I know I am seeing someone not too deeply rooted in reality. For the sake of the argument: what if someone gave Uganda enough money to resolve the problem of poverty among its people for good, offered in addition free education, state-of-the-art free health care to everyone living in Uganda etc, provided that consenting adults be permitted to engage in 'unnatural' sex if they so wish. Any government minister who would be prepared to sacrifice the well-being of the people in such a case for the sake of fighting 'unnatural' sex is obviously a nutcase. Consequences be damned is very Christian, of course, but it also not very smart.

Anyhow, I digress, I really meant to write about the 'natural' and the 'unnatural', and that I will do, but let me first give you the second example. We owe it to a Christian 'Senator' in Jamaica. I don't know Jamaica too well, so I presume Senators are not overly well educated people relying on tax hand outs for a living while preaching hate. So, without further delay, in her own words, Jamaican Senator Hyacinth Benneth: "For many persons that push a radical homosexual agenda it is claimed that homosexual behaviour is natural for them. That particuar [sic!] group has been quite successful in advancing their cause by using the rights based approach. I am not a psychologist or a psychiatrist but I have not seen where homosexual behaviour has been conclusively shown to be natural. In fact the dominant scientific opinion has been that no one can conclusively show that homosexuality is natural."

Ms Benneth is probably unaware of the fact that there is no dominant scientific opinion on the naturalness or otherwise of homosexuality. The reason for this is that this issue is not a scientific question to begin with. It's a matter of what you mean when you call something 'natural'. In science EVERYTHING that is physically possible by necessity is considered a natural thing. Anything governed by the laws of nature is natural. So, for that reason alone there can't be a body of scientific opinion on the naturalness of homosexuality anymore than there can be a body of scientific literature on the naturalness of any number of other things that are happening within what the laws of nature permit (namely: everything that is physically possible). So, dear Ms Benneth, your claim about the views of 'science' on the naturalness of homosexuality (wrong as it is even in fact), also aims to take comfort from the wrong people. It's akin to someone saying in response to a question such as what is the proper way to lay pipes in a housing estate? that there is a consensus opinion of theologians on the matter. It makes no sense, and even if theologians had views on how to lay pipes in a housing estate they're not really competent to claim particular expertise.

What does this mean? Not too much. Gay activists, do not rejoice too quickly. A lot of crap happens in nature. Crocodiles eat tourists in the Australian Northern Territory just about every year. Very much a natural thing, but still it's not nice. Men (usually) rape women. Natural. People drive cars. Natural. People fly to the moon. Natural. People kill each other in genocides. Natural. People bake cakes. Natural. You get the drift, I'm sure.

What we could do now, of course, is to change our definition of natural. Say, we could add a bit of Christianity and dump an imaginary God into the equation. What the claim about the naturalness of homosexuality then means is that homosexuality is a violation of a normatively understood (human) nature. Of course, this has even less to do with science - poor Hyacinth, how did you manage to get all of this so badly wrong... - This, after all, is what really motivates our Ugandan and Jamaican crusaders. There's a lot of irony in this one, too. After all, if anybody is unnatural, God is. The God these folks have invented hovers above the laws of nature, this God even makes laws of nature. Now, if anything is unnatural, God is. Funny enough, they're not going on about outlawing God or God's unnatural behavior (say, 'miracles'). Nope, they aim to punish people who do things within the laws of nature that their imaginary (and all-powerful, and all-knowing, and 'good') God cooked up in a couple of days. So, if anything, even on their own perspective, it's probably not a good idea to question God's laws of nature and the conduct that happens as a result of God's magnificent work (including, of course, genocides, rapes, and other such niceties). If I was God, I certainly would be pretty miffed if my underlings (sorry, my chosen one's) would question my grand scheme of things.

There's other problems with 'nature'. We have seen already that so many things 'go' in nature that are clearly bad, that it is obvious to anyone other than Ms Benneth and Dr Buturo that nature is probably a bad yardstick to measure any kind of behaviour against. There's a logical reason for that, too, it's called a naturalistic fallacy. A naturalistic fallacy occurs each time when someone derives normative conclusions from a matter of fact. You can't do that. You always need normative arguments and analysis to achieve that feast. So, gay activists, from the fact that homosexuality occurs in nature it follows that it is natural. It does not follow that it is good. The same is true for ice cream, the new Boeing Dreamliner, sunshine and other such things.

What Ms Benneth and Dr Buturo REALLY are trying to sell to the unsuspecting public is a normative (as opposed to a scientific) understanding of nature. Ie they have decided that certain things in nature are bad and they label them unnatural. We can probably all agree that there's plenty of things in nature that are not nice. The thing is though, Dr Buturo and Ms Benneth need to argue their case. Some of their ilk have argued that homosexual sex is unnatural because it is not leading to reproduction. That is, the homosexuals' use of our sexual organs is unnatural because it doesn't lead to breeding. So, in that sense then some guy sticking his penis in another guys bum is an abuse of the penis (and presumably the bum), because the sperm is wasted in the wrong spot so to speak. Well, there's several problems with this: 1) Most heterosexual sex acts involving the penis and the vagina (or other orifices of the heterosexual sex partner) do not lead to reproduction. Should we outlaw those, too? 2) Why should we accept the argument that our bodily organs serve only one purpose and no other. After all, we are using our tongue to lick stamps these days, as well as ice cream and any number of other things. What is the natural function of the tongue in these circumstances? And, who is to decide? Hyacinth and her buddy from Uganda? 3) Why should we accept the idea that sex serves only one purpose, namely to breed? I mean, why can't we accept the novel idea that sex (hopefully more often than not) is kinda FUN, Ms Benneth and Dr Buturo? As you can see, your claim that some kind of conduct or other is unnatural alone won't cut it. In fact, if anything, it is begging the question.

Wednesday, July 01, 2009

50 Voices of Disbelief, an interview with Russell Blackford and Udo Schuklenk

Have you ever wondered why Michael Shermer is an atheist, or Margaret Downey, or A.C. Grayling, or James Randi, or Victor Stenger, or many other well known atheists? You will be able to find out this coming fall. The new book “50 Voices of Disbelief: Why We Are Atheists” by Russell Blackford and Udo Schuklenk is a collection of essays by some of the most prominent on why they are atheists. Inspirational stories and philosophical monologues will provide a doorway into the author’s life, and shed some light on their journey to the land of non-belief.

Both authors agreed to a small interview to tell readers more about their book and why they’ve decided to create it. If you’re intrigued by this book, read this interview and you will see that it is a must read for any atheist. If you’re still hiding in the “closet”, this book will inspire and give you energy to kick the door open and tell everyone that you’re an atheist. Just think about it, reading these stories is like having conversations with Austin Dacey, Peter Singer, Lori Lipman Brown, and many more. Why not immerse yourself into the lives of your favorite authors and people you admire?

Udo Schuklenk. Photo credit: Landry Karege

Whose initial idea was it to create this book and why?

Udo: I think it was my idea. I have been involved in academic publishing for some 15 years or so by now and at one point one gets a reasonable sense for what might or might not work in the market place. We have seen a series of monographs by folks like Sam Harris, Christopher Hitchens and Richard Dawkins, all of which were wildly successful. It seems the time is ripe for a project where high-profile people from all walks of public life are given an opportunity to declare their disbelief, as well as their reasons for not buying into the fairy tale of an all-knowing, all-powerful, good God. I guess my main motive was some kind of frustration (that’s putting it mildly) about religious people’s published musings about how they "struggled to find God" only to eventually succumb to the delusions we all know too well. It seemed only fair game to me to let reality-based people explain why they did better.

Russell: Yes, it was Udo's idea. Of course, I jumped at it when he asked me to come on board. I was enthusiastic about the idea and flattered that he thought my skills would be useful.

Russell Blackford. Courtesy of Russell Blackford.

How did Russell get involved in this project?

Udo: Russell and I knew each other professionally. He and I studied and worked at one point at Monash University, both of us work within bioethics, and both of us are known atheists. I asked him how he felt about putting together an anthology of Voices of Disbelief (the title was conceived in the end by Russell), and it didn’t take much to persuade him that this was a viable project.

Russell, on your blog you mentioned that the book was originally called Voices of Disbelief. Did the publisher recommend a different title or was there something else that brought the change?

Russell: Voices of Disbelief was our working title for most of the project, but we discussed a number of possible variations even during the earliest phases, before we found a publisher. At one stage we were thinking of something like Why I Am Not A Believer: Voices of Disbelief. Throughout the process of putting the book together, we returned from time to time to the question of the final title - in discussions with each other, with editorial staff at Wiley-Blackwell, and, on a few occasions, in talking to individual contributors.

The important thing, was to have something punchy and commercially attractive, while also emphasizing the many and diverse perspectives, or "voices", included in the book. The specific reference to atheism in thre sub-title was proposed by Wiley-Blackwell staff, insofar as it signals that the book contributes to the same debate about religion as the so-called "New Atheist" books of Richard Dawkins and others whom Udo has mentioned – though there's a question about what the New Atheism really is …

Also, it became apparent towards the end of the work on the book - as we got a clearer and clearer idea of the final line-up - that the eventual number of contributors/essays would be very close to exactly fifty, a nice round number. We've actually ended up with fifty essays, fifty contributors in addition to the two editors, and fifty-two contributors in total (since each editor has written an essay, but two of the essays have two co-authors each).

Along with the folks at Wiley-Blackwell, we brainstormed several variations of these elements, as well as some possible titles that would have been quite different. The way I remember it, I made a suggestion at the end that involved using the "50" on the cover, though I didn't actually mean as part of the title. The final title was a version of my suggestion that then came back from the folks at Wiley-Blackwell. It brought together everything that we'd been talking about. We signed off on that version straight away. It felt right to both of us.

People say don't judge the book by its cover, but before we get inside the book we need to know what the cover represents. From my research I understand that there was another cover considered, a collage of images of contributors. Why a blown out candle with smoke floating off to the side?

Udo: My own preference was for a cover featuring thumbnail images of each contributor, but we faced logistical difficulties getting those organized. Also, the publishers’ marketing people were probably rightly concerned that this just wasn’t a striking enough cover design to motivate people perusing books in bookstores to pick up the volume and open it.

The flickering candle is normally understood as a symbol of believers’ connection with their imaginary God. Our intention, of course, is to sever that link and accordingly we blew the candle out on our cover. I am curious whether people who see the cover will see it that way…

Russell: There may be some confusion around arising from the fact that Roy Natian was kind enough to put together a very simple collage of some of the contributors to go on the book's Facebook group, pending the final cover being decided. But the Facebook image that Roy created was only a place marker, and we never looked at an actual cover along those lines – as Udo says, it was logistically difficult to do it properly. We actually considered a large number of images, but settled on the candle design for its power and for its classy appearance.

Actually, though, I don't "read" the symbolism in the way that Udo describes. I expect that that will be how most people see it initially, but I hope they'll then do a cognitive shift to seeing it as the candle of reason or Enlightenment, which is blown out in so many places and circumstances by religious nonsense. As we say in the book's introduction, it is very difficult to keep the candle of reason alight at a time when unreason in many forms is resurgent. But each essay is one small effort on behalf of the candle of reason, one contribution to keeping it alight. That reinterpretation is reinforced by the interior design: when you open the book, you see one lit candle for each essay, on the essay's first page!

I worry that, especially as the Millennium edges nearer, pseudoscience and superstition will seem year by year more tempting, the siren song of unreason more sonorous and attractive. Where have we heard it before? Whenever our ethnic or national prejudices are aroused, in times of scarcity, during challenges to national self-esteem or nerve, when we agonize about our diminished cosmic place and purpose, or when fanaticism is bubbling up around us-then, habits of thought familiar from ages past reach for the controls. The candle flame gutters. Its little pool of light trembles. Darkness gathers. The demons begin to stir.

I think this is the perfect example of how a blown out candle is a result of religious superstition, invading the light of reason and logic. I’m just curious, did Carl Sagan’s popular “candle in the dark” metaphor play any role in the cover?

Russell: In my case, yes, I was aware of Sagan's imagery at the time we were choosing the cover, and of the passage you've quoted, though other authors have also used this image and I don't know whether Sagan was the first. Whether or not he was, he certainly popularized it, and the passage is one that's worth remembering and returning to from time to time.

Udo, your March 17th, 2009 blog entry mentions publication date as September 10th, but Amazon lists it as October 19th. Why was the date pushed back?

Udo: Nothing sinister here, simply small delays in the production process.

Russell: We are still looking at September 10 in the UK and October 19 in the US, but we were originally hoping for something more like August. The exact date of publication of any book is always a little bit flexible – even if a manuscript is delivered on time, which ours pretty much was, there is always a great deal that happens in the production process between then and final publication.

Is this book part of the New Atheism movement? Why or why not?

Russell: Well, what's the New Atheism movement? I think the expression is often used pejoratively to attack anyone who argues against religion. The best sense that I can make of "the New Atheism" is that it is a return of normal transmission – a return of perfectly normal and proper criticism of religion in the public sphere, after this seemed to become taboo during the 1980s and 1990s. We have to thank Dawkins and others for breaking the taboo, so in that sense I suppose the book can be seen as part of the so-called New Atheism.

But note that there's no party line that our contributors had to follow. For example, some essays express strong agreement with particular views associated with Dawkins; others, however, are critical of Dawkins. The contributors were free to express their own views about religion, the various arguments for and against it, and the future role of religious organizations, without fear that we'd attempt to get them to conform. As Udo likes to say, we're not the Vatican. Hey, we don't even agree with each other about everything, not even in this interview.

Russell, your April 7th, 2009 blog entry says, “I expect to see more and more people speaking up. There are plenty who have been holding their fire until now, as Udo Schuklenk and I found when we began to put together Voices of Disbelief .” You were talking about New Atheism, religion, and bioethics in this entry. What did you mean by “holding their fire until now”? How did this book brought this up?Russell: In that blog post, I gave, as an example, my strong sense that many people in the bioethics community were fed up with religious meddling – what I see as a religious resistance to rational bioethics. That was only one example, but it's a good one. In matters of life and death, such as choices about reproductive technologies, abortion, euthanasia, and so on, people with views grounded in religion have demanded a kind of deference to their assumed authority. Often, they have gone a long way towards wresting the discipline of bioethics from secular philosophers.

But this is just one example of the deference that religionists have claimed, with considerable success.

All too often, religion demands and receives deference in the political sphere. And yet, over recent decades it became taboo to criticize religion strongly in public. Partly, there was an assumption among those who might be expected to oppose it, such as members of the academic Left, that secularization was inevitable, that religion was receding as a social force – so it was no longer necessary to oppose it actively. There was also a feeling that criticizing religion somehow involved a taint of Western imperialism. Remember that a large part of the intellectual output of the academic Left in recent times has been devoted to attacks on the Enlightenment and modernity. Of course, most elements of the Right (not all, but certainly most) have always found wisdom in religion. One way or another, something of a social consensus formed that religion must not be criticized and must be treated as either harmless or beneficial.

Not all of us agreed with this, but speaking out was discouraged by many elements of society. Although I chafed at this situation, I held my fire – as I put it in the blog post. I kept it to mysef. I had many reasons for this, including the fact that the various jobs that I held through most of the 1980s and 1990s until 2001 involved roles where it would have been inappropriate to speak out strongly on matters of religion. For example, I was a fairly senior public servant at one stage. But as I say in my own essay in 50 Voices of Disbelief, I also tended until about the late 1990s to subscribe to the inevitable secularization theory. It's notable that even academics and professional writers, people with great freedom to speak up and be controversial, tended not to criticize religion in any way and to frown on those who did.

Things have changed. Secular bioethicists are one group who are particularly fed up. But many events have shown that religion and its political power are not going away in a hurry. This includes the rise of Islamic terrorism, the politicization of Christian fundamentalism in the US, and the many attempts to control our private decisions on matters of how we live and die. I think that more and more people who have avoided talking about religion in public are now keen to speak out and say what they really think.

I don’t know if you’ve seen a recent episode of Bill Maher’s show but in this episode he said that “Democrats are the new Republicans.” Generally speaking we would see Republicans as the Right and Democrats as the Left, of course with some exceptions. But the point I’m trying to bring is what if this shift didn’t happen in politics? What if it was a larger shift of the Left closer to the center, while the Right began to bury itself in religious fundamentalism, which is so popular in America. This is where New Atheism comes in, it is the answer to the conservative shift of the Left. Russell, you said that new atheism is “a return to normal transmission.” Isn’t this exactly what it is? People are not used to the normal - this is why they criticize New Atheism as extreme.

Russell: I haven't seen that episode – I don't see Bill Maher's show regularly, but only if there's a particular reason – but I do agree strongly with your last point. Once it becomes taboo to discuss religion in any way other than the most deferential, or to criticise it in any way other than the most detached and impersonal, usually tucked away from the public in philosophical journals or expensive academic monographs, the point is soon reached where any kind of normal criticism of religion can be depicted as extreme. It never ceases to amaze me that Dawkins is characterized as "strident" or "extreme"; sure, he can sometimes be blunt or passionate, but most of what he says and writes is in a very courteous and measured tone, carefully qualified where needed, and often enlivened by humor. Some other authors, Christopher Hitchens among them, do go closer to the sort of robust language that is used all the time in criticising political opponents. But I resent the fact that critics of religion are branded as uncivil and destructive, often even by fellow unbelievers, and even when their tone and rhetoric might be quite mild by the standards applying everywhere else in public debate about ideas – about political agendas or economic theories, for example.

Udo: I concur with your analysis of where the Republicans and Democrats are located on the political spectrum. I always tell my US friends and colleagues that the Democratic Party in the US is probably closest to the conservative wing of the Conservative Party in my native Germany, and that the Republican Party likely would be monitored by the security services as a clear a present danger to the democratic state. The mainstream political spectrum in the USA is located much further to the right than it is in Europe and Australia/New Zeland. There is a broad consensus in the US mainstream political discourse that rails against public health care, for absolute freedom of speech, and such issues that you wouldn't find supported by most Europeans, including myself. I doubt, however, that what you call the 'New Atheism' could realistically be the answer of the political Left to this US peculiarity. The reason for this is that there are plenty of very right-wing (in economic terms, in terms of social justice etc) atheists. Vice versa, there's plenty of left-wing Christians, for instance. I am probably closer to the views of many Catholics on the issue of international justice and poverty eradication than I am to the views of libertarian atheists. In short: I doubt there is a straigtforward connection between atheism and the political Left beyond the rejection of the idea of God. To my mind that is good news. I'm perfectly happy to join forces on the God issue with atheist right-wingers. When we are done with 'God' we can have a rational debate about other political issues.

Udo, what is your experience with “holding their fire until now” statement in which Russell mentioned you?

Udo: I think this probably is country-to-country and culture-to-culture dependent. In Canada where I moved only about two years ago you have a predominantly secular society. Amongst most of my colleagues in the Department of Philosophy it's taken as a given that you are an atheist or agnostic of some kind or other. People probably wouldn’t even think it’s worth speaking out about this, because it’s so self-evident to them that you cannot be reality based and believe in the God the monotheistic ideologies are marketing to us. The same is more or less true for France. In Britain on the other hand, where I also worked on and off, you have a much more militant atheist community. There is a very long tradition of speaking out. After all, Roman-Catholic Tony Blair led the country into a futile war against a predominantly Muslim country, aiding and abetting his fellow Christian crusader George W. Bush. In those sorts of countries people do speak out against the belief in God precisely because much more is at stake. Religious belief in those countries causes untold harm, hence the backlash from reality based people is growing stronger. Mind you, you can even see this in a country as backwardly religious as Jamaica, for instance, where debates between atheists and the religious establishment are raging even in mainstream newspapers. The tide is turning as ever more people speak out against religious fairy tales. Reminds me of Richard Dawkins who said (I am paraphrasing here): There is more to religion than vicars giving tea parties, there are evil consequences!

Udo you call this book “a humanist/atheist coming out party “, do you think it will inspire atheists who are still “in the closet” to come out?

Udo: I hope so. With a bit of luck the book might be adopted for college courses and might encourage students to join us in speaking out. Who knows, people might use it as an alternative Christmas gift and so initiate discussions with their believing friends, relatives and colleagues. Especially in societies that are very religious, books such as ours could have a significant impact. They have the potential to make skeptical people realize that they actually are not alone at all in their doubts.

Udo, Russell, what course, do you think, would benefit from this book as textbook? Philosophy? Ethics? Or something else? And are you planning on using it in your own classrooms?

Russell: I'm not likely to be doing any teaching after this year – I hope to maintain some kind of honorary research position at Monash or another university, but will otherwise be writing and editing full time. However, I can see the book being used in a range of courses. Most obviously, it could be used in philosophy of religion courses, but, for example, a course in sociology might also look at contemporary debates about religion. That could include the New Atheism phenomenon, however that is best understood.

Udo: Yep, I agree with Russell. This volume could be used in any number of courses and disciplines ranging from philosophy to cultural studies, and politics.

When you approached the publisher, how did they react? What did they say?

Udo: This has not been difficult at all. I have been working with Wiley-Blackwell for close to a decade and produced books as well as academic journals for and with them. They were very excited and very supportive from the start about the project.While contacting contributors, what was the general feeling you got from them about the project?

Udo: We have not had serious difficulties attracting contributors – in fact, we had to turn down a few who approached us when word spread about the forthcoming anthology. It is true that a few authors we would have liked to attract turned us down, but this was not because they did not see the value of the project. They were plain overwhelmed with other work, tragedies in their family lives, the types of things that prevent you sometimes from doing the things you would like to do. I can’t think of anyone who turned us down because of doubts about the project.

Russell: Reactions varied of course, but we were generally met by a tremendous amount of enthusiasm. It even came from some of the people who were too heavily committed to contribute. No doubt different individuals had different motivations varied, but there was a strong mood that this was going to be a timely book, an opportunity for many people to have their say, all in one place, as to why they reject religion and the authority over us that it claims. We were tapping into a lot of widespread resentment, all over the world, of religion's claim to be able to tell us how to live our lives, and, in many cases, to tell governments what conduct to permit or not permit its citizens.

Lastly, why should anyone buy it? How will it enrich their lives?

Udo: Honestly, what surprised me most is how many of the contributors took our invitation seriously and divulged their personal reasons for being atheists. I found their essays most enlightening and entertaining. It’s greatly enriching to learn about these well-known people’s struggles that led them down the reality-based path. There are also contributions that are strictly academic and analytical in nature. As a philosopher I appreciate a carefully constructed and expressed analysis. So, in a sense, the mix and diversity of our voices is what makes this volume such a rich anthology.

Russell: What Udo said … and I want to emphasize the sheer diversity of the book. The contributors don't always agree with each other on such things as the future of religion, or how conciliatory we should be towards its more liberal manifestations. But that just makes the book even more thought provoking.